<p>Challenges and Future Prospects of Precision Medicine in Psychiatry</p>

Abstract

Precision medicine is increasingly recognized as a promising approach to improve disease treatment, taking into consideration the individual clinical and biological characteristics shared by specific subgroups of patients. In specific fields such as oncology and hematology, precision medicine has already started to be implemented in the clinical setting and molecular testing is routinely used to select treatments with higher efficacy and reduced adverse effects. The application of precision medicine in psychiatry is still in its early phases. However, there are already examples of predictive models based on clinical data or combinations of clinical, neuroimaging and biological data. While the power of single clinical predictors would remain inadequate if analyzed only with traditional statistical approaches, these predictors are now increasingly used to impute machine learning models that can have adequate accuracy even in the presence of relatively small sample size. These models have started to be applied to disentangle relevant clinical questions that could lead to a more effective management of psychiatric disorders, such as prediction of response to the mood stabilizer lithium, resistance to antidepressants in major depressive disorder or stratification of the risk and outcome prediction in schizophrenia. In this narrative review, we summarized the most important findings in precision medicine in psychiatry based on studies that constructed machine learning models using clinical, neuroimaging and/or biological data. Limitations and barriers to the implementation of precision psychiatry in the clinical setting, as well as possible solutions and future perspectives, will be presented.

Exploring the Role of Gut Microbiota in Major Depressive Disorder and in Treatment Resistance to Antidepressants

“…Similarly, treatment response prediction, if informed by reliable clinical and biological data, could increase the success of pharmacological treatment of MDD, reducing the quandary of the trial and error approach and ultimately leading to the identification of the most effective drug on an individual basis in a timely manner [7]. However, although research on risk prediction has produced clinically relevant models [8], treatment response prediction remains lacking [9].…”

“…To date, most of the studies implementing predictive models of response used information from gene sequence variants [7], while dynamic biological processes, such as modifications in the transcriptome, epigenome, proteome, metabolome or gut microbiota have been less explored. Of particular interest is the recent literature suggesting that altered gut microbiota composition might indeed interfere with the mechanism of action of antidepressants and in modulating their clinical efficacy [14].…”

Investigating aberrantly expressed microRNAs in peripheral blood mononuclear cells from patients with treatment‑resistant schizophrenia using miRNA sequencing and integrated bioinformatics

“…Therefore, precision medicine for this particular type of SCZ requires to be urgently implemented in the clinic. Although precision medicine is a novel healthcare discipline ( 40 ) that gives priority to the unique characteristics of specific patients ( 41 ), its use in psychiatry is still lagging compared with other medical fields, since it relies on neuroimaging and/or biological technology to provide a benefit ( 42 , 43 ). Several studies have made outstanding contributions to the development of precise psychiatric medical treatments.…”

Increasing engagement in pharmacology and pharmacogenetics education using games and online resources: The PharmacoloGenius mobile app

“…However, the terms pharmacogenetics and pharmacogenomics are often used interchangeably (Pirmohamed, 2001). (Manchia et al, 2020). One of the actionable barriers is the fact that a substantial part of physicians and pharmacists found themselves not to have enough knowledge on pharmacogenetics or desiring to acquire higher confidence in the topic (Just et al, 2017;Karuna, Tragulpiankit, Mahasirimongkol, & Chumnumwat, 2020;Kim, Kim, Oh, & Shin, 2020;McCullough et al, 2011;Petit, Croisetiere, Chen, & Laverdiere, 2020;Pisanu et al, 2014).…”

“…Pharmacogenetics is a growing field of pharmacology. It consists in the identification and characterization of the influence of the genetic profile on the interindividual variability in drug response (Hockings et al, 2020), and aims to achieve personalized medicine, that is, tailoring treatment based on relevant clinical and biological characteristics shared by specific subgroups of patients (Hockings et al, 2020; Manchia, Pisanu, Squassina, & Carpiniello, 2020; Marrero et al, 2020). The term pharmacogenetics is mainly used in relation to single or few specific genes able to affect drug response, while the term pharmacogenomics is a broader term that refers to hypothesis‐free profiling of the whole genome.…”